DENTIST: TOP JOB IN 2017

Transcription

1 Summer 2017 FOR PROVIDERS PARTICIPATING IN ACCESS DENTAL GOVERNMENT-FUNDED PROGRAMS IN CALIFORNIA DENTIST: TOP JOB IN 2017 According to the U.S. News & World Report, if you re a Dentist, you have the best job in the United States. Based on determining components, occupations are ranked based on overall score. Using a single weighted average score, Dentists scored highest. Orthodontists and Oral and Maxillofacial Surgeons were also in the top ten occupations. U.S. News & World Report: The Bureau of Labor Statistics predicts employment growth of 18 percent between 2014 and 2024, with 23,300 new openings. A comfortable salary, low unemployment rate and agreeable work-life balance boost dentist to a top position on our list of best jobs.

2 SB137 PASSED BY CALIFORNIA LEGISLATURE SB137, commencing July 1, 2016, would require the Department of Managed Health Care and the Department of Insurance to develop uniform provider directory standards. It requires a health care service plan or health insurer to take appropriate steps to ensure the accuracy of the information contained in the plan or health insurer s directory or directories, and would require the plan or health insurer, at least annually, to review and update the entire provider directory or directories for each product offered, as specified. In order to meet the requirements of SB137, we will need the support of our provider community each of whom will be expected to meet the following requirements: Provider agrees to notify Access Dental within five (5) business days of the date when the Provider will no longer accept new patients and, if the Provider had previously not accepted new patients, when the Provider resumes accepting new patients; Provider agrees to cooperate with Access Dental s periodic outreach to verify the Provider s information listed in our provider directory. The Provider shall provide an affirmative response to our inquiries regarding the accuracy of the Provider s information in the Access Dental provider directory. If a Provider repeatedly fails to alert Access Dental about changes in the Provider s information that is required to be included in the provider directory, we shall have the option to terminate the Provider s Agreement with Access Dental. The following information is required to be included in the provider directory: a) name; b) practice address; c) city; d) ZIP code; e) California license number; f) National Provider Identifier number; g) telephone number; h) type of practitioner; i) area of specialty, including board certification, or other accreditation; j) provider office address, if available; k) name of provider group; l) languages spoken; m) indicator identifying providers who no longer accept new patients; n) product; and o) tier. If you have any questions about this new law or what is required of you to fulfill your Access Dental Agreement, please contact your Provider Representative for further information. The law was passed in an effort to ensure that all members of dental plans throughout California are given the most current and correct information within the provider directory. If you would like to read the entire bill, click here

3 PROVIDER BONUS PROGRAMS Effective January 1, 2015 Access Dental enacted compensation changes that established Quarterly Utilization Incentive Compensation for Kids (QUICK PAY) programs to further reward network dentists for providing care to our members. There are two bonus schedules: Annual Dental Visit 5-11 Kids Preventive Package You will receive additional compensation through these schedules if you meet the minimum utilization required. PHP (LOS ANGELES) GMC (SACRAMENTO) Ranges Payment Ranges Payment >=57.0% to <59.0% $0.40 PMPM >=59.0% to <61.0% $0.50 PMPM >=61.0% $0.60 PMPM >=47.0% to <49.0% $0.40 PMPM >=49.0% to <51.0% $0.50 PMPM >=51.0% $0.60 PMPM The bonus PMPM will be based on the provider office Annual Dental Visit utilization. Utilization will be run following the Q4 Performance Measure Benchmark (PMB) reportletters of notification and contract amendments were sent out initially in March Complete information (including procedures that are included in these programs and utilization requirements) were included. If you have not received this information, please contact your Access Dental Provider Relations Representative and a new packet will be forwarded to you. Your Provider Relations Representative will be available to work with you in order to best maximize bonus payments. Feel free to reach out to them to ask questions or if you or your staff is in need of training, your Representative is here to help.

4 NEW INFECTION CONTROLS BEING CONSIDERED The California legislature is considering a bill that has been developed to improve infection control safety in dentistry. Introduced by Tom Daly (D-Anaheim), Assembly Bill 1277 calls for the Dental Board of California to amend the regulations on the minimum standards for infection control for certain dental procedures that expose the dental pulp and may create an opportunity for infection. The California Dental Association (CDA) worked with Daly in drafting the bill. The bill was partially inspired by an outbreak of 22 confirmed and 46 probable mycobacterial infections of children between the ages of 2 and 11 years who had received pulpotomies in one California practice. The outbreak and traced the infections to the practice s water system. The bill adds Section to the Business and Professions Code of the California Code of Regulations. According to the bill, This bill would require the board to amend the regulations on the minimum standards for infection control to require water or other methods used for irrigation to be sterile or contained recognized disinfecting or antibacterial properties when performing dental procedures that expose dental pulp. The bill requires the board to adopt final regulations on or before December 31, It is now in the Assembly Business and Professions Committee awaiting a vote. - See more at: To prevent the buildup of biofilm in dental waterlines, the CDA recommends the purging of waterlines at the beginning of each workday and flushing lines between patients; reviewing procedures for maintaining dental water unit quality at equal to or less than 500 cfu/ml heterotrophic water bacteria; and consulting with the manufacturer of the dental unit for appropriate water maintenance methods.

5 STUDY SHOWS E-CIGARETTES CAUSE DAMAGE TO GUM TISSUE A new study by the University of Rochester Medical Center proposes that electronic cigarettes are equally as damaging to gums and teeth as conventional cigarettes, The study provides the first scientific study to address e-cigarettes and their detrimental effect on oral health on cellular and molecular levels. This is the first scientific study to address e-cigarettes and their detrimental effect on oral health on cellular and molecular levels. Electronic cigarettes continue to grow in popularity because they are often perceived as a healthier alternative to conventional cigarettes. Previously, scientists thought that the chemicals found in cigarette smoke were the culprits behind adverse health effects, but a growing body of scientific data, including this study, suggests otherwise. We showed that when the vapors from an e-cigarette are burned, it causes cells to release inflammatory proteins, which in turn aggravate stress within cells, resulting in damage that could lead to various oral diseases, explained the study lead. How much and how often someone is smoking e-cigarettes will determine the extent of damage to the gums and oral cavity. The study, which exposed 3-D human, non-smoker gum tissue to the vapors of e-cigarettes, also found that the flavoring chemicals play a role in damaging cells in the mouth. And it is important to remember that e-cigarettes contain nicotine, which is known to contribute to gum disease. Most e-cigarettes contain a battery, a heating device, and a cartridge to hold liquid, which typically contains nicotine, flavorings, and other chemicals. The battery-powered device heats the liquid in the cartridge into an aerosol that the user inhales. Journal Reference: 1.Isaac K. Sundar, Fawad Javed, Georgios E. Romanos, Irfan Rahman. E-cigarettes and flavorings induce inflammatory and pro-senescence responses in oral epithelial cells and periodontal fibroblasts. Oncotarget, 2016; DOI: /oncotarget University of Rochester Medical Center. First-ever study shows e-cigarettes cause damage to gum tissue. ScienceDaily. ScienceDaily, 16 November <

6 LANGUAGE ASSISTANCE SERVICES Premier Access maintains a Language Assistance Program (LAP) to assist members who have limited English language proficiency. This program is used to better communicate with members and to help them participate more fully in their dental health care. We will work with providers and members to provide any vital documents in the member s preferred language, as well as telephone or face-to-face interpreting services. These services are available to Access Dental and Premier Access members free of charge and can be arranged through our Customer Services Department. As a participant in the Premier Access and Access Dental networks, you must comply with the requirements and standards established by LAP. Further information is contained within the Provider Manual on the Premier Access website with regarding to this program and your responsibilities. If you have additional questions relative to this program, please contact Customer Services at and request the Premier Access Policy regarding language assistance. Please note that Grievance Forms are available in threshold languages (those languages identified as primary in your area) on the Premier Access website in the Forms section of the Provider module. Denti-Cal would like to advise providers that American Sign Language (ASL) translation services are available to Denti-Cal beneficiaries who may need these services. Either the Denti-Cal provider office or the beneficiary may contact Denti-Cal directly to request an ASL translator to be present at the time of the appointment. If you have any questions and are a Denti-Cal Provider, please contact the Provider Customer Service Line at

7 ENCOUNTER INFORMATION: WHY IT S IMPORTANT The encounter data you submit monthly are due to Access Dental by no later than the 15th of each month. The data helps us analyze: Accountability: utilization, access and quality analysis Underwriting and risk management Other research and evaluation studies. Access Dental, like all carriers, is held accountable by the State for providing or arranging all medically necessary care funded by the benefit package for a defined population. State and Federal governments need to assure that patients are getting the care that they need. Though oversight of this issue occurs in a variety of ways (e.g., external reviews, onsite inspection, consumer complaints and grievances), administrative data are a useful tool for broad tracking and profiling to identify potential problem areas. IMPORTANT! Encounter Forms are due by the 15th of each month. Make sure you submit yours on time.

8 CONTACT INFORMATION: Your Provider Representative can be reached through Provider Services at The Premier Access website is your dedicated source for patient information, forms and news.